Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.50 / $71.88 / $286.89	Facility	26	$62.50	$71.88	$286.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $250.00 / $370.50 / $546.25	Professional		$250.00	$370.50	$546.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.50 / $102.59 / $154.00	Professional	26	$62.50	$102.59	$154.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $187.50 / $262.50 / $385.24	Professional	TC	$187.50	$262.50	$385.24
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $162.33 / $162.33 / $233.87	Professional		$162.33	$162.33	$233.87
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $59.90 / $62.89 / $131.18	Professional	26	$59.90	$62.89	$131.18
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.41 / $93.41 / $252.09	Facility	26	$93.41	$93.41	$252.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $201.90 / $425.00 / $867.29	Professional		$201.90	$425.00	$867.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.53 / $101.38 / $170.34	Professional	26	$58.53	$101.38	$170.34
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $147.11 / $314.23 / $710.99	Professional	TC	$147.11	$314.23	$710.99
Florida Blue Facility/Professional Facility Modifier 26 Low / Median / High Price $92.21 / $92.21 / $92.21	Facility	26	$92.21	$92.21	$92.21
Florida Blue Facility/Professional Professional Modifier Low / Median / High Price $293.25 / $462.51 / $639.83	Professional		$293.25	$462.51	$639.83
Florida Blue Facility/Professional Professional Modifier 26 Low / Median / High Price $58.12 / $89.90 / $123.45	Professional	26	$58.12	$89.90	$123.45
Florida Blue Facility/Professional Professional Modifier TC Low / Median / High Price $207.02 / $371.95 / $534.94	Professional	TC	$207.02	$371.95	$534.94
Molina Facility/Professional Professional Modifier Low / Median / High Price $95.09 / $203.78 / $358.05	Professional		$95.09	$203.78	$358.05
United Facility/Professional Professional Modifier Low / Median / High Price $242.84 / $375.39 / $770.77	Professional		$242.84	$375.39	$770.77
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.13 / $75.66 / $164.25	Professional	26	$64.13	$75.66	$164.25
United Facility/Professional Professional Modifier TC Low / Median / High Price $171.78 / $289.89 / $647.24	Professional	TC	$171.78	$289.89	$647.24
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $208.21 / $208.21 / $208.21	Professional		$208.21	$208.21	$208.21
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $60.85 / $60.85 / $60.85	Professional	26	$60.85	$60.85	$60.85
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $147.35 / $147.35 / $147.35	Professional	TC	$147.35	$147.35	$147.35